title: [Physiognomy-accompanying auditory hallucinations in schizophrenia: psychopathological investigation of 10 patients].
abstract: We previously reported two schizophrenic patients with characteristic hallucinations consisting of auditory hallucinations accompanied by visual hallucinations of the speaker's face. The patient sees the face of the hallucinatory speaker in his/her mind and hears the voice talking inwardly. We termed these experiences physiognomy-accompanying auditory hallucinations. In this report, we present 10 patients with schizophrenia showing physiognomy-accompanying auditory hallucinations and evaluate the characteristics of these clinical symptoms. Moreover we consider what the symptoms mean for patients and the metabasis from structural aspects. Lastly, we consider how we can treat these patients living autistic lives with the symptoms. During physiognomy-accompanying auditory hallucinations, the realistic face moves its mouth and talks to the patient expressively. In early onset cases, the faces of various real people appear talking about ordinary things while in late onset cases, the faces can be imaginary but are mainly real people talking about ordinary or delusional things. We suppose that these characteristics of the symptoms unify the schizophrenic world overwhelmed by "a force of non-sense" to "the sense field". "The force of non-sense" is a substantial power but cannot be reduced to the real meaning. And we suppose that not visual reality but the intensity of auditory hallucinations of the face brings about the overwhelming intensity of symptoms and the substantiality of this intensity depends on the states of excessive fullness of "the force of non-sense". With these symptoms patients see the narration of auditory hallucinations through the facial image and the content of auditory hallucinations is compressed into the movement of visual hallucinations of the speaker's face. The form of symptoms is realistic but the speaker's face and voice are beyond ordinary time and space. The symptoms are essentially different from ordinary perception. The visual hallucinations of the speaker's face in "physiognomy-accompanying auditory hallucinations" has the same structural nature as typical auditory hallucinations in schizophrenia. Further the symptoms are different from the organic hallucinations caused by the pathology of consciousness. After onset the patients seem to restructure their living world to coexist with the symptoms. What we can do in treatment is to regard coexistence with the symptoms as a way of life and consider the roles of the symptoms in the patients' world and grope for the possibility that the patients may be able to live without depending on the pathological world.
authors.affiliation: Asahi Hospital.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagashima
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006212:Hallucinations / Q000523:psychology*; D006801:Humans; D008297:Male; D010826:Physiognomy; D012565:Schizophrenic Psychology